Page 27 - Megatel Homes LLC Benefit Guide 8-1-2025v3

Voluntary Accident (On and Off The Job):

Lincoln Financial

Benefit Amount Other Injuries Amount
Hospital Class 1 Lacerations Class 1
Admission $1,000 Less than 2 inches $450
Daily Confinement (Up to 365 days per $200 per day 2 inches to 6 inches $750
accident) Greater than 6 inches $1,500
ICU Confinement (Up to 15 days per ac- $400 per day
cident) No repair required $125
Rehab. Facility Confinement (Up to 30 $100 per day Burns Class 1
days per accident) 2nd degree <= 9% TBSA $250
Surgical Class 1 2nd degree 10 - 18% TBSA $350
Arthroscopic (365 days) $575 2nd degree 19—36% TBSA $950
Abdominal/Cranial/Thoracic (365 days) $1,500 2nd degree > 37% TBSA $1,500
Herniated Disc (365 days) $600 3rd degree < 9% TBSA $1,400
Torn Knee Cartilage (365 days) $1,200 3rd degree 10 –18% TBSA $3,600
Ligament/Rotator Cuff/Tendon (365 $1,200 3rd degree 19 –36% TBSA $7,500
days) 3rd degree > 37% TBSA $15,000
Eye Procedure (90 days) $375 Skin Graft (% of burn benefit) 50%
Blood Products (90 days) $400 Note: “TBSA” is an acronym for “total body surface area.”
Pain Management (90 days) $125 Dental Care Class 1
Diagnostic Class 1 Crown or Filling Repair $300
X-Ray $175 Extraction $250
Diagnostic Exam $200
Concussion $400 Benefit Amount
Class 1 Child age 26 or younger is in- 25% of benefit amount
Physician Follow-Up Office Visit (Up to $75 jured in a sanctioned school
6 visits) sport or a competitive sport re-
Therapy Services (Up to 10 sessions) $25 quiring registration.
Medical Device $100
Prosthetic Device(s) (Per Limb) $750
HOSPITAL, SURGICAL & DIAGNOSTIC BENE-
Benefit Amount FITS
Class 1 Initial hospital admission and confinement must begin
Transportation $300 per trip within 90 days of an accident. ICU confinement must
Lodging (Up to 30 nights per accident) $125 per night
Childcare (Up to 30 days per accident) $20 per day begin within 30 days of an accident. Surgical treatment
Benefit Amount timeframes vary by the type of surgery. Diagnostic ser-
vices, except for X-Ray, must be received within 30 days

Benefit Amount of an accident. X-Ray services must be received within 90
Health Screening test (1 test per 12 $50 days. Except for confinement benefits, most benefits are
months) payable once per accident per insured person.

If any surgery listed below occurs concurrently with an
Open Reduction for a Fracture or Dislocation of the same
Health screening tests include: accident/fall prevention counseling
(adult only); annual physical; child immunizations (DTP, MMR, Rota-
virus, Chickenpox, Meningitis); child sports/school physicals; child
Costs Per Pay Period
concussion screening; dental preventative exams; depression screen-
ing; eye exam; hearing exam; osteoporosis screening (adult only);
substance abuse screening/counseling; tetanus immunization.
Employee Employee+ Employee + Employee +
Only Spouse Child(ren) Family
$6.29 $10.47 $11.56 $15.65

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